“There are many things the College is working hard on — and with great success. Lung cancer screening, fair billing, and better representation in the RVS Update Committee all come to mind,” says Loralie D. Ma, MD, MA, PhD, FACR, medical director of the Greater Baltimore Medical Center (MRI and PET-CT), chair of the ACR’s State Government Relations Committee, and state government relations chair for the Maryland Radiological Society. “Those are things state chapters might not make much headway on in state legislatures,” she says. “The ACR is very good at working with states at the grassroots level and providing information to state chapters on  the hot-button issues in radiology across the country.”

States may have varying priorities on what they need to protect, Ma says, citing the issue of self-referral as an example. “Maryland has been big on protecting against self-referral, for instance, but other states may not have the same strategy,” Ma says. The ACR has always supported the key work of state radiology chapters, which can then shape federal policy. As the ACR works to reimagine its relationships with its state-level counterparts, leaders are further defining the wants and needs of chapters, while exploring opportunities to deliver tailored assistance. Moving forward, the ACR’s mission is to grow support for state chapter efforts — while lobbying for fair and positive changes within the specialty.

Driving Change

Many members may not know how tenaciously the ACR’s Commission on Governmental Relations fights on their behalf — and on behalf of their patients — to ensure the best practices for high-quality care and fair reimbursement for expertise. The government relations department is the College’s voice to the U.S. Congress, state legislatures, and federal and state agencies and regulatory bodies. Its goal is to influence legislation and regulations to the benefit of patients, the radiology profession, and ACR members.

“The ACR plays a critical role in bringing the voice of radiologists to policymakers on behalf of the patients we serve,” says ACR President Geraldine B. McGinty, MD, MBA, FACR. “As we seek to eliminate health disparities, it is critical that we influence policy — and that we are proactive and aggressive on issues surrounding imaging services for all patients.”

In 2020, an ACR-led coalition worked to make significant changes to the language proposed in the newly passed Consolidated Appropriations Act, 2021 (Omnibus and Coronavirus Relief Bill). The coalition — including representation of more than 1 million providers — achieved a significant reduction in anticipated Medicare provider payment cuts due to evaluation and management (E/M) coding changes, phased-in implementation of E/M adjustments, and a vastly improved policy on surprise medical billing. The ACR’s leadership also helped secure a one-year delay of the radiation oncology payment model in the 2020 year-end legislation. The ACR and its coalition partners will continue working with regulators, the new Congress, and the Biden Administration to advance these policies in a manner that protects patients, ensures access to care, and reduces the effects of payment adjustments on providers who are still reeling from the financial hit COVID-19 dealt.

The ACR, along with other leading medical societies and patient advocacy groups, also formed the #ReturnToCare Coalition last year to address fears around avoiding important imaging services during the pandemic (learn more at returntocarecampaign.org). The coalition encouraged patients (in areas where COVID-19 conditions were appropriately safe) to consult their doctors to discuss returning for imaging and other necessary medical services they had postponed.

“Building on the momentum of last year’s successes, the ACR will continue to work diligently with lawmakers and regulators to promote better payment policies that bolster sustainable healthcare quality and access,” says Howard B. Fleishon, MD, MMM, FACR, chair of the ACR BOC.

More recently, the ACR announced that it will serve as a convener for the Radiology Health Equity Coalition to ensure the best care for every patient, regardless of background or income level. The coalition will work with organizations like the AMA and the American Hospital Association to get input from their experiences and experts. While these are examples of ACR’s advocacy and leadership successes on the national playing field, building stronger relationships with state chapters to advance their individual agendas is equally important to achieve fair policies and safe practices.

Supporting States

State chapters offer ACR members opportunities to attend local meetings, connect with other radiologists, and get involved as radiology advocates at the grassroots level. The states can also drive the ACR’s national policy and procedures through the ACR Council, the legislative body of the College that provides a voice to each ACR member though their chapters.

The ACR is very good at working with states at the grassroots level and providing information to state chapters on the hot-button issues in radiology across the country.

“We need to build on our current work with state chapters, while rethinking how we can best advance their initiatives,” says Josh Cooper, ACR vice president of government relations and economics health policy. “We need to understand exactly what we can do for them — to continue to be more valuable and supportive.” According to Ma, when it comes to advancing an agenda to benefit radiologists and the patients they serve, resource challenges exist. “No two states are the same,” she says. “Not even the big states are the same, though some of them may have more resources — like their own lobbyists.”

Regardless of size, each chapter needs individualized support related to its strategic goals. “Many states also want the independence to champion issues specific to their state in their own way,” says Ma. State chapters think differently about what is important, she notes, with some issues carrying more weight than others depending on the chapter.

Reimagining the ACR’s approach to advocacy offers the opportunity to reengage with state chapters and the patients and members we all serve, Fleishon says. “Rather than assume what they want, we need to invite them into the process and build relationships based on broad input,” he says.

Engaging Members

The ACR’s state affairs group is strategizing ways to get members more engaged in the issues surrounding radiology and healthcare in general. “We’re looking at coalition-building at the state level,” says Eugenia Brandt, the ACR’s director of state affairs.

“For example, we may collaborate with surgeons or other specialty physicians on insurance mandates for cancer screening,” she says. This could include colorectal screening and screening mammography, as well as testing for skin cancers and childhood and obstetric cancers. “We would also like to produce ‘Tell Your Story’ video shorts — high-quality clips highlighting success stories around state-level advocacy,” Brandt says.

The state affairs group looks to hold a state advocacy roundtable meeting — virtual or in-person yet to be determined at the time of this writing. The roundtable meeting would be in addition to the ACR’s annual meeting. “The feedback we’ve gotten from the chapter leaders so far has indicated that they are very much interested in holding additional formal or informal roundtables that promote networking and provide another opportunity to interact with other state chapter leaders and colleagues,” says Brandt. “We are planning to organize or possibly cosponsor a ‘Day at the State Capitol’ event with interested chapters, and we hope to award grant program funding to state chapters whose proactive efforts carve a path to state legislation supporting core pillars of ACR — advancing radiology and protecting patients.” The ACR government relations department also plans to build out its social media presence in the near future, Cooper says. The team is cautiously optimistic, with an eye on maintaining accuracy and integrity in its online messaging around regulatory and legislative goals.

“Everything is on the table,” Fleishon says. “Not only what services the ACR provides but how we deliver content. We are breaking down silos and fostering new ways to communicate and collaborate.”